Diagnosis Methods
- Patient self-report
- Actigraphy data
- EEG monitoring
- PSG monitoring
- Sleep laboratory studies
Treatment Consideration Table
| Sleep Disorder | Treatment Consideration |
| Primary Insomnia | Improved sleep hygiene Melatonin Refer for cognitive behavioral therapy |
| Secondary Insomnia | Improved sleep hygiene Melatonin Pain management SSRIs Refer for cognitive behavioral therapy |
| Circadian Rhythm Disorder, Delayed Sleep Onset | Improved sleep hygiene Melatonin Bright light therapy in morning/reduced light exposure in evening prescribed sleep/wake scheduling |
| Circadian Rhythm Disorder, Advanced Sleep Onset | Improved sleep hygiene Melatonin Bright light therapy in evening /reduced light exposure in morning Prescribed sleep/wake scheduling |
| Hypersomnia/Narcolepsy | Stimulant medications Strategic caffeine Prescribed naps |
| Periodic Limb Movement | Gabapentin Dopamine agonists |
| Obstructive Sleep Apnea | Refer for sleep study |
Notes
Pharmacological Interventions - Sleep medications are not highly efficacious for some TBI-related sleep disorders and may come with high risk for dependency and other side effects.
- Melatonin has the lowest side effect profile among sleep medications.
- Trazodone is not well studied in the TBI population but is widely used and should theoretically have fewer negative effects on neural plasticity than other drug classes discussed.
- Newer drugs such as zolpidem have fewer side effects than benzodiazepines but may also interfere with neural plasticity.
- Benzodiazepines may result in residual cognitive deficits and may interfere with normal recovery from TBI.
Non-Pharmacological Interventions
- Improvement of sleep hygiene is a particularly important factor – This may include avoidance of sleep disturbing factors such as consuming caffeine late in the day, utilizing electronic devices prior to bed, avoiding bright lights, adhering to a regular sleep schedule, and avoiding other factors which may disturb sleep.
- Referral to a psychologist for psychological interventions such as to develop better sleep hygiene and treat anxiety which may be contributing to sleep dysfunction
- Sleep restriction therapy to resume a regular sleep schedule may also be indicated. This includes scheduling sleep/wake times. Typically a mental health professional such as a psychologist may assist with developing an appropriate schedule.
- Coping with fatigue - building rest breaks into schedules, reducing work hours, and minimizing distractions. A graduated approach may then be taken in increasing stamina and engagement in activities as the patient is able to tolerate
References
Mazwi, N., Fusco, H., & R. Zafonte (2015). Sleep in traumatic brain injury. In Handbook of Clinical Neurology, Vol. 128. J. Grafman and A.M. Salazar, Eds. Elsevier.
Singh, K., Morse, A., Tkachenko, N., & S. Kothare (2016). Sleep disorders associated with traumatic brain injury – A review. Pediatric Neurology, 60, 30-36.
Lucke-Wold, B., Smith, K., Nguyen, L., Turner, R., et al. (2015). Sleep disruption and the sequelae associated with traumatic brain injury. Neuroscience and Biobehavioral Reviews, 55, 68-77.
Ponsford, J., & K. Sinclair (2014). Sleep and fatigue following traumatic brain injury. Psychiatric Clinics of North America, 37, 77-89.
Baumann, C. (2016). Sleep and traumatic brain injury. Sleep Medicine Clinics, 11, 19-23.
Larson, E., & F. Zollman (2010). The effect of sleep medications on cognitive recovery from traumatic brain injury. Journal of Head Trauma Rehabilitation, 25, 1, 61-67.